Contraceptive implant and injectable

Synopsis

Use the 2026 five-year etonogestrel implant licence and distinct DMPA interval, interaction, bleeding, bone and return-to-fertility rules safely.

The etonogestrel implant is a single radiopaque rod that now provides licensed UK contraception for five years; the change covers both existing and new implants.
The five-year licence is not an eight-year LNG-IUD extension. Record the insertion date and remove or replace by five years unless pregnancy is desired sooner.
Hepatic enzyme induction reduces implant efficacy throughout treatment and for 28 days after stopping; offer DMPA, LNG-IUD or copper IUD rather than relying on early implant replacement.

Key red flags

Nexplanon is licensed in the UK for up to five years from insertion as of 13 May 2026, applying to implants already in place and newly inserted devices.

Enzyme-inducing medicines can reduce implant effectiveness during use and for 28 days afterwards; DMPA and intrauterine methods are unaffected.

A non-palpable implant may be deeply inserted, migrated or absent; exclude pregnancy and localise it before removal.

DMPA is scheduled every 13 weeks and can be given up to 14 weeks from the last injection without additional precautions; later return requires EC and pregnancy assessment.

Severe pain, neurovascular symptoms or signs of infection after implant insertion or removal need urgent examination and specialist referral.

Deep or migrated implant

Failure to palpate, neurological symptoms or location away from the insertion site requires imaging and expert removal.

Late DMPA return

More than 14 weeks since the previous injection ends the no-backup grace interval and requires pregnancy-risk assessment.

Possible pregnancy

New pregnancy symptoms or pelvic pain after interaction or late injection requires testing and ectopic safety-netting.

Investigation priorities

Insertion and injection recordFirst step

Confirm product, exact date, site, lot and calculated replacement or repeat date.

Management branches

Implant pathwayInsert, palpate and date five years

An eligible patient chooses etonogestrel implant contraception.

Exclude pregnancy reasonably, review enzyme-inducing medicines and counsel about bleeding, duration and procedure risks.
Insert subdermally with trained technique, palpate the whole rod with the patient and document product, site and date.

Key medicines

Etonogestrel implant 68mgInsert one radiopaque rod subdermally in the non-dominant upper arm for up to five years of contraception under the UK licence current from May 2026.Enzyme inducers reduce efficacy during use and for 28 days after; confirm palpability, investigate pregnancy symptoms and localise before difficult removal.

Depot medroxyprogesterone acetateGive the licensed intramuscular or subcutaneous preparation at its product dose every 13 weeks; administration up to 14 weeks after the last injection needs no extra contraception.Discuss bleeding, weight, temporary bone-density loss, delayed fertility return and inability to remove the dose; after 14 weeks assess EC and pregnancy risk.

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